Healthcare Provider Details

I. General information

NPI: 1033391206
Provider Name (Legal Business Name): MELANIE HLAVACKA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5717 NE 138TH AVE
PORTLAND OR
97230-3409
US

IV. Provider business mailing address

5717 NE 138TH AVE
PORTLAND OR
97230-3409
US

V. Phone/Fax

Practice location:
  • Phone: 503-261-7541
  • Fax: 503-261-2048
Mailing address:
  • Phone: 503-261-7541
  • Fax: 503-261-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number9569
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: